Nick Scott1, Anna Palmer2, Christopher Morgan3, Olufunmilayo Lesi4, C Wendy Spearman5, Mark Sonderup5, Margaret Hellard6. 1. Disease Elimination Program, Burnet Institute, Melbourne, VIC, Australia; School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia. Electronic address: nick.scott@burnet.edu.au. 2. Disease Elimination Program, Burnet Institute, Melbourne, VIC, Australia. 3. Disease Elimination Program, Burnet Institute, Melbourne, VIC, Australia; School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia; Melbourne School of Population and Global Health, University of Melbourne, Parkville, VIC, Australia. 4. Gastroenterology and Hepatology Unit, Lagos University Teaching Hospital, Lagos, Nigeria. 5. Division of Hepatology, Department of Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa. 6. Disease Elimination Program, Burnet Institute, Melbourne, VIC, Australia; Department of Infectious Diseases, Alfred Health's Infectious Diseases Unit, Monash University, Melbourne, VIC, Australia.
Abstract
BACKGROUND: The controlled temperature chain (CTC) strategy allows vaccines to be kept outside the cold chain for a short period of time. In remote rural areas, the CTC strategy for the hepatitis B virus (HBV) birth dose vaccination could improve its geographical coverage and timeliness of delivery, but with additional outreach costs. We assessed the cost-effectiveness of the CTC strategy for the HBV birth dose across six world regions and 72 countries according to their HBV prevalence, delivery costs, and birth dose coverage and timing. METHODS: By use of a mathematical model of perinatal HBV transmission and disease progression, we calculated per 1000 births the total HBV-related disability-adjusted life-years (DALYs) and costs, including vaccine delivery costs and costs associated with HBV-related disease, with and without the CTC strategy. FINDINGS: A CTC strategy produced health benefits in all regions and was cost-saving in the regions of east Asia and Pacific, Latin America and Caribbean, sub-Saharan Africa, and north Africa and Middle East. The CTC strategy cost US$0·15 (IQR -7·11 to 4·75) per DALY averted in the central and eastern Europe and central Asia region and $79·72 (66·47 to 94·47) in the south Asia region. Within individual countries, more savings were achieved and more DALYs averted in areas with above average HBV prevalence, below average birth dose coverage, or later than average birth dose delivery. INTERPRETATION: A CTC outreach strategy that improves the timing and coverage of the HBV birth dose vaccination is likely to be cost-saving and reduce the burden of HBV infection associated with perinatal transmission. FUNDING: Burnet Institute.
BACKGROUND: The controlled temperature chain (CTC) strategy allows vaccines to be kept outside the cold chain for a short period of time. In remote rural areas, the CTC strategy for the hepatitis B virus (HBV) birth dose vaccination could improve its geographical coverage and timeliness of delivery, but with additional outreach costs. We assessed the cost-effectiveness of the CTC strategy for the HBV birth dose across six world regions and 72 countries according to their HBV prevalence, delivery costs, and birth dose coverage and timing. METHODS: By use of a mathematical model of perinatal HBV transmission and disease progression, we calculated per 1000 births the total HBV-related disability-adjusted life-years (DALYs) and costs, including vaccine delivery costs and costs associated with HBV-related disease, with and without the CTC strategy. FINDINGS: A CTC strategy produced health benefits in all regions and was cost-saving in the regions of east Asia and Pacific, Latin America and Caribbean, sub-Saharan Africa, and north Africa and Middle East. The CTC strategy cost US$0·15 (IQR -7·11 to 4·75) per DALY averted in the central and eastern Europe and central Asia region and $79·72 (66·47 to 94·47) in the south Asia region. Within individual countries, more savings were achieved and more DALYs averted in areas with above average HBV prevalence, below average birth dose coverage, or later than average birth dose delivery. INTERPRETATION: A CTC outreach strategy that improves the timing and coverage of the HBV birth dose vaccination is likely to be cost-saving and reduce the burden of HBV infection associated with perinatal transmission. FUNDING: Burnet Institute.
Authors: Sophia E Schröeder; Alisa Pedrana; Nick Scott; David Wilson; Christian Kuschel; Lisa Aufegger; Rifat Atun; Ricardo Baptista-Leite; Maia Butsashvili; Manal El-Sayed; Aneley Getahun; Saeed Hamid; Radi Hammad; Ellen 't Hoen; Sharon J Hutchinson; Jeffrey V Lazarus; Olufunmilayo Lesi; Wangsheng Li; Rosmawati Binti Mohamed; Sigurdur Olafsson; Raquel Peck; Annette H Sohn; Mark Sonderup; Catherine W Spearman; Tracy Swan; Mark Thursz; Tim Walker; Margaret Hellard; Jessica Howell Journal: Liver Int Date: 2019-09-04 Impact factor: 5.828
Authors: T Hugh Guan; Hnin Nandar Htut; Colleen M Davison; Shruti Sebastian; Susan Andrea Bartels; Soe Moe Aung; Eva Purkey Journal: PLoS One Date: 2021-12-20 Impact factor: 3.240
Authors: Christopher P Seaman; Anna-Lea Kahn; Debra Kristensen; Robert Steinglass; Dijana Spasenoska; Nick Scott; Christopher Morgan Journal: Bull World Health Organ Date: 2022-06-22 Impact factor: 13.831